To Grid or not to Grid...

I love general paediatrics! It’s so varied with the potential to lead you anywhere. The team ethos is hard to beat and it’s where most of us started…our paediatric home. It’s a fascinating and rewarding speciality and that’s why it was so difficult to hang up my general paediatric hat and make the decision to apply for grid training.

I’ve not clicked the submit button yet so there’s always the potential to change my mind but I think after much agonising I have finally made the big bad decision. The problem is you see that within each area of paediatric medicine, there are bits that I enjoy. On the neonatal unit, my inner scientist came out as I watched physiology in action in intensive care. In the community I enjoyed making small


differences to everyday life and truly understood what a multidisciplinary team could achieve. In fact when you look at the long list of 16 sub-specialities there are good things about all of them (although I was pretty sure clinical pharmacology wasn’t for me…)

So how to decide…That was the dilemma. If you had to list the top three things that you find rewarding in your job, what would they be?

Mine were as follows-

  1. Getting my teeth into a really complex case and fully understanding every aspect of it

  2. Establishing a solid relationship with a patient and their family over time

  3. Working with a wide variety of professionals and providing full holistic care for a patient, making a real difference to their daily lives

Now, to be honest, you probably could experience all of those things in any area of paediatric training. So I also thought about the things I didn’t enjoy…After all you could be a consultant in your chosen area for thirty years or more, so you’d better be able to tolerate it.

The worst things about my job are:

  1. Not having enough time on the ward or in clinic to spend with my patient and to provide care to the standard that I would like

  2. Practical procedures- They’re just not really my thing. I don’t get a buzz from that difficult procedure. I just get stressed when the child cries!

  3. Research- I just don’t feel very comfortable discussing research, I don’t have much experience in it and I tend to shy away from overly complicated papers. I find it easier when the clinical application is evident…


All of this led me to the conclusion that Community Paediatrics was for me. This along with the fact that I found Child Protection work rewarding and was fascinated by childhood behaviour and development and what drives it.

It’s worth thinking about GRID early and if you’re stuck like I was trying the strategy above. If you’re still unsure, speak to others trainees on that grid programme or try asking for a rotation in that area. This could be as early as your SHO years. The programme directors are often more than happy to accommodate your wishes.

Also, you need to have a contingency plan. Not everybody get’s there GRID training on their first attempt. If you’re sure about sub-specialising don’t default to General Paediatrics. It deserves better…Also you’ve already done most of the hard work getting your CV in shape. Instead do something valuable towards your potential career or identify the gaps in your experience (potentially the dreaded research!) and plan your time well before reapplying. Often the deanery can place you on a rotation linked to your preferred sub-speciality so that you can later count that experience towards sub-specialty training.

Once you’ve started in your speciality of choice, that doesn’t mean that you have to leave the others behind. Keep updated. Stay competent. Those skills are likely to come in handy when you least expect it!

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